{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:40:50Z","timestamp":1787244050707,"version":"build-2736575974"},"reference-count":23,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Objectives: This study aimed to describe the incidence and clinical spectrum of external cephalic versi\u00f3n (ECV)-related complications, to evaluate pre-procedural predictors of their occurrence, and to develop and internally validate a prediction model for ECV-related complications. Methods: This single-center cohort study included ECV procedures performed in singleton pregnancies with non-cephalic presentation at term between January 2014 and December 2025. All procedures followed a standardized protocol, including tocolysis and either deep sedation or spinal anesthesia. ECV-related complications were defined as maternal or fetal adverse events occurring during the procedure or within 24 h after ECV. A prespecified multivariable logistic regression model was developed using clinically relevant pre-procedural variables. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC), and internal validation was performed by bootstrap resampling. Results: A total of 1050 ECV procedures were included, of which 733 (69.7%) were successful. Complication status was available for 1050 procedures, among which 113 ECV-related complications were recorded (10.8%). Complications were more frequent after failed than successful ECV (17.6% vs. 7.8%). The most frequent events were non-reassuring fetal heart rate patterns, major vaginal bleeding, spotting, and uterine contractions. Emergent cesarean delivery within 24 h occurred in 72 complication cases (63.7%). No neonatal deaths occurred among cases with ECV-related complications. In the final multivariable model, lower maternal body mass index (adjusted OR 0.92 per kg\/m2), lower deepest vertical pocket (adjusted OR 0.69 per 10 mm), and breech rather than transverse lie (adjusted OR 0.24) were independently associated with ECV-related complications. Adding deepest vertical pocket significantly improved model discrimination from an AUC of 0.645 to 0.714. Bootstrap internal validation demonstrated limited optimism, with an optimism-corrected AUC of 0.699. Conclusions: ECV performed under a standardized protocol achieved a high success rate with an acceptable safety profile, although approximately one in ten procedures was associated with an ECV-related complication when broadly defined. Lower maternal BMI, reduced amniotic fluid volume, and breech presentation were the main pre-procedural predictors of complications. These findings may facilitate individualized counselling and procedural planning, although external validation is required before clinical implementation.<\/jats:p>","DOI":"10.3390\/jcm15166443","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T09:48:31Z","timestamp":1787219311000},"page":"6443","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and Internal Validation of a Multivariable Prediction Model for Complications After External Cephalic Version in Singleton Term Pregnancies"],"prefix":"10.3390","volume":"15","author":[{"given":"Rosa Mar\u00eda","family":"Gallego-Pozuelo","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u2018Virgen de la Arrixaca\u2019 University Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inmaculada Concepci\u00f3n","family":"Delgado-Gonz\u00e1lvez","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u2018Virgen de la Arrixaca\u2019 University Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam Isabel","family":"Garc\u00eda-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u2018Virgen de la Arrixaca\u2019 University Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estrella","family":"Naranjo-D\u00edaz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u2018Virgen de la Arrixaca\u2019 University Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Var\u00f3-Torrecillas","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u2018Virgen de la Arrixaca\u2019 University Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"C\u00e1mara-Cases","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u2018Virgen de la Arrixaca\u2019 University Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margarita","family":"Gonz\u00e1lez-Guill\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u2018Virgen de la Arrixaca\u2019 University Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romina Sol","family":"Liandro","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u2018Virgen de la Arrixaca\u2019 University Hospital, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2831-9975","authenticated-orcid":false,"given":"Alberto Rafael","family":"Guijarro-Campillo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u2018Virgen de la Arrixaca\u2019 University Hospital, 30120 Murcia, Spain"},{"name":"Department of Obstetrics and Gynecology, Pediatrics and Surgery, University of Murcia, 30120 Murcia, Spain"},{"name":"Maternal-Fetal Medicine, Reproduction and Gynecology Research Group, Biomedical Research Institute of Murcia Pascual Parrilla\u2013IMIB, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catalina","family":"de Paco-Matallana","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u2018Virgen de la Arrixaca\u2019 University Hospital, 30120 Murcia, Spain"},{"name":"Department of Obstetrics and Gynecology, Pediatrics and Surgery, University of Murcia, 30120 Murcia, Spain"},{"name":"Maternal-Fetal Medicine, Reproduction and Gynecology Research Group, Biomedical Research Institute of Murcia Pascual Parrilla\u2013IMIB, 30120 Murcia, Spain"},{"name":"Spanish Network in Maternal, Neonatal, Child and Developmental Health Research (RICORS-SAMID, RD24\/0013\/0018), Instituto de Salud Carlos III, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4253-3556","authenticated-orcid":false,"given":"Javier","family":"S\u00e1nchez-Romero","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u2018Virgen de la Arrixaca\u2019 University Hospital, 30120 Murcia, Spain"},{"name":"Department of Obstetrics and Gynecology, Pediatrics and Surgery, University of Murcia, 30120 Murcia, Spain"},{"name":"Maternal-Fetal Medicine, Reproduction and Gynecology Research Group, Biomedical Research Institute of Murcia Pascual Parrilla\u2013IMIB, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"ref_1","first-page":"CD003928","article-title":"Cephalic Version by Moxibustion for Breech Presentation","volume":"2023","author":"Coyle","year":"2023","journal-title":"Cochrane Database Syst. 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Gynaecol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6443\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T10:10:09Z","timestamp":1787220609000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6443"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,20]]},"references-count":23,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166443"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166443","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,20]]}}}